Pakistan Pakistan

Trends in ageing and health Pakistan Pakistan

Key points

In 2015, non-communicable diseases (NCDs) accounted for 86 per cent of deaths among people aged 50 and over. Deaths due to chronic obstructive pulmonary disease (COPD) were more prevalent among men aged 50 to 69 and 70 and over than among women in the same age groups. Deaths due to cancers were more prevalent among women aged 50 to 69 and 70 and over than among men in the same age groups. Prevalence of violence was significantly higher among older women than among men.

2 Trends in ageing and health: Pakistan Ageing and longevity in Pakistan

A The population of Pakistan will surpass 244 million by 2030. The Figure H1: Population structure in Pakistan older population (aged 60 and over) is predicted to continue to increase, Pakistan while the youngest population (aged 0 to 14) will continue to decrease 60 as a proportion of the total population through to the end of the century 0 (Figure H1). The population aged 60 and over is expected to increase by 3.3 per cent annually between 2015 and 2050, reaching 12.9 per cent of 20 the total population.B Percentage 0 Both men and women are living longer. While women are expected to 150 2000 2050 2100 outlive men by 1.8 years, the number of years spent in poor health – the ear gap between life expectancy and healthy life expectancy – is greater for 0-1 50 60 80 women (9.5 years) than for men (8.1 years) (Figure H2). Source: United Nations, Department of Economic and Social Affairs, Population DivisionC Ageing and shifting patterns of disease and disability

As the population ages, the burden of disease in Pakistan is shifting. NCDs accounted for 78.2 per cent of total years lived with disability Figure H2: The gap between life expectancy (LE) and healthy life expectancy (HALE) in Pakistan in Pakistan in 2015. NCDs are the leading cause of disability across Pakistan all age groups for both sexes, ranging from 78 per cent of years lived Feae ae with disability among women aged 15 to 49 and 80 per cent for men 100 100 of the same age, to 85 per cent for both men and women aged 70 and 80 80 2 5 5 over (Figure H3). Communicable diseases (CDs) and injuries constitute 8 81 Ga 60 60 nearly 20 per cent of this burden among people aged 15 to 49. 0 0 NCDs increased and CDs decreased from 1990 to 2015, across all age 5 52 52 51 20 20 8 6 6 Ga groups and sexes. Across the life course in Pakistan, we see a change in 0 0 the types of NCD that cause disability. At later stages of life (age 70 and and H in years 2000 2005 2010 2015 2000 2005 2010 2015 over), cardiovascular disease (CVD) is responsible for 8.8 and 9.2 per ear cent of disability among women and men, respectively, and COPD for L at birth AL at birth L at age 60 AL at age 60 7 and 10.8 per cent among women and men, respectively. Diabetes becomes more prominent as a cause of disability, for both women and Source: World Health OrganizationD men, than during the earlier stages of life (ages 15 to 49).

Trends in ageing and health: Pakistan 3 Figure H3: Years lived with disability in Pakistan Figure H4: Causes of death in Pakistan

Pakistan 154 years Pakistan 154 years Feae ae Feae ae 100 100 100 100 0 0 0 0 80 80 80 80 0 0 0 0 60 60 60 60 50 50 50 50 0 0 0 0 30 30 30 30 Percentage 20 20 Percentage 20 20 10 10 10 10 0 0 0 0 10 15 2000 2005 2010 2015 10 15 2000 2005 2010 2015 10 15 2000 2005 2010 2015 10 15 2000 2005 2010 2015 ear ear

CD COPD Cancers CD COPD Cancers Pakistan 56 years Pakistan 56 years D Other NCDs I/AID D Other NCDs I/AID Feae ae Feae ae 100 Others CDs Inuries100 100 Others CDs Inuries100 0 0 0 0 80 80 80 80 0 0 0 0 60 60 60 60 50 50 50 50 0 0 0 0 30 30 30 30 Percentage 20 20 Percentage 20 20 10 10 10 10 0 0 0 0 10 15 2000 2005 2010 2015 10 15 2000 2005 2010 2015 10 15 2000 2005 2010 2015 10 15 2000 2005 2010 2015 ear ear

CD PakistanCOPD 7 years Cancers CD PakistanCOPD 7 years Cancers DFeae Other NCDs aeI/AID DFeae Other NCDs aeI/AID 100 Others CDs Inuries100 100 Others CDs Inuries100 0 0 0 0 80 80 80 80 0 0 0 0 60 60 60 60 50 50 50 50 0 0 0 0 30 30 30 30 Percentage 20 20 Percentage 20 20 10 10 10 10 0 0 0 0 10 15 2000 2005 2010 2015 10 15 2000 2005 2010 2015 10 15 2000 2005 2010 2015 10 15 2000 2005 2010 2015 ear ear

CD COPD Cancers CD COPD Cancers Diabetes Other NCDs I/AID Diabetes Other NCDs I/AID Other CDs Inuries Other CDs Inuries

Source: Institute for Health Metrics and EvaluationE Source: Institute for Health Metrics and EvaluationF

4 Trends in ageing and health: Pakistan The number of deaths related to NCDs has increased in the last 25 years across generations and sexes, with higher rates of NCD-related deaths among older people (Figure H4). NCDs accounted for 62.4 per cent of Figure H5: Prevalence of major depressive disorders in Pakistan, all deaths among men and women in Pakistan in 2015, and was as 2016 high as 86 per cent among individuals aged 50 to 69, and 70 and over. 10 Pakistan Among older people (aged 70 and over), CVDs are the dominant cause of mortality for both men and women – about 50 per cent of the total 8 burden of disease. However, there are differences between genders:

6 diabetes and cancer are greater causes of mortality among older women, and COPD is greater among older men. female This pattern of causes differs considerably in younger adults. Among Prevalence () 2 male people aged 15 to 49, NCD-related deaths have been steadily increasing among younger cohorts, with CVD being the leading NCD cause of 0 50-5 55-5 60-6 65-6 0- 5- 80-8 85-8 0- 5 death for men, and cancer for women. CDs were the second leading Age (years) Range Average cause of death for women (32 per cent), and injuries were the second male male leading cause for men (26 per cent). female female

Source: Institute for Health Metrics and EvaluationG Ageing, mental health and cognitive impairment

The prevalence of major depressive disorders in Pakistan is increasing among men and women between the ages of 50 and 80, after which it Figure H6: Self-harm mortality rates in Pakistan decreases (Figure H5). Women have higher rates of major depressive Pakistan disorders than men across all age groups. Feae ae 10 10 Looking at the burden of deaths resulting from injuries, specifically 8 8 self-harm, rates were higher among women than men across all age

6 6 cohorts in the early 1990s (Figure H6). The female self-harm mortality

rate began to fall around 2000 for the cohorts aged 50 to 69, and around 1995 for those 70 and over; it is below the self-harm rate for men of the

1 eoe 2 2 ortaity rate er same age. 0 0 Rates of dementia in Pakistan are similar for men and women, with 10 15 2000 2005 2010 2015 2016 10 15 2000 2005 2010 2015 2016 ear the prevalence in both sexes increasing rapidly after the age of 70 15- 50-6 0 (Figure H7). Source: Institute for Health Metrics and EvaluationH

Trends in ageing and health: Pakistan 5 Prevalence of violence towards older people

The prevalence of physical, sexual and psychological violence is much Figure H7: Alzheimer’s and other dementias in Pakistan, 2016 higher among older Pakistani women than older men (Figure H8). For 50 Pakistan example, about 15 per cent of women aged 80 to 84 experienced violence 5 in 2016 compared with about 6.5 per cent of men in the same age group. 0 35 30 25 Poverty and health financing 20 female 15 Prevalence () Household out-of-pocket health expenditure in Pakistan decreased 10 male 5 from 73.1 per cent of total health expenditure in 2008 to 66.5 per cent 0 in 2015.K Per capita out-of-pocket health expenditure increased slightly 50-5 55-5 60-6 65-6 0- 5- 80-8 85-8 0- 5 L Age (years) from $88 in 2008 to $89.4 in 2015. Range Average male male It is not possible to analyse expenditure or access to health insurance, female female mandatory or voluntary, by age group due to lack of age disaggregation Source: Institute for Health Metrics and EvaluationI in the relevant international datasets. Older people remain largely invisible within the monitoring of universal health coverage (UHC). The UHC Index (Table H1) measures coverage Figure H8: Physical, sexual and psychological violence in Pakistan, 2016 of a range of essential services. Currently, these include two of particular concern to older people: access to treatment for diabetes and Pakistan 25 for hypertension. However, gaps in the data sources used to track UHC female mean that we do not have systematic findings on older people’s access 20 to these treatments. 15 Table H1. Selected health and care indicators 10

Prevalence () Category Indicators 5 male UHC Index Coverage of essential services under 40 0 N 50-5 55-5 60-6 65-6 0- 5- 80-8 85-8 0- 5 2015 (median universal health coverage Age (years) value)M Range Average male male Financial Incidence of catastrophic health 1.03 female female protection (%) expenditureO J Source: Institute for Health Metrics and Evaluation Long-term care Gap in universal coverage of long-term No data and support careP

6 Trends in ageing and health: Pakistan Endnotes

A Up from 197.01 million in 2017. United Nations, Department of Economic and K World Health Organization, Out-of-pocket expenditure (% of current health expenditure), Social Affairs, Population Division,Profiles of ageing 2017, https://population.un.org/ https://data.worldbank.org/indicator/SH.XPD.OOPC.CH.ZS?locations=PK (23 September ProfilesOfAgeing2017/index.html (22 October 2018) 2018) B Author calculation based on data from United Nations, Department of Economic and L World Health Organization, Out-of-pocket health expenditure per capita (PPP current Social Affairs, Population Division,World population prospects: the 2017 revision, DVD international dollars), 2015, https://data.worldbank.org/indicator/SH.XPD.OOPC. Edition, 2017 PP.CD?locations=PK (23 September 2018) C United Nations, Department of Economic and Social Affairs, Population Division, M The UHC Index measures coverage of essential health services, defined as the average Probabilistic population projections based on the world population prospects: the 2017 coverage of essential services based on tracer interventions that include reproductive, revision, http://esa.un.org/unpd/wpp (18 October 2018) maternal, newborn and child health, infectious diseases, NCDs and service capacity and D World Health Organization, Life expectancy and healthy life expectancy: data by country, access, among the general and most disadvantaged populations. It is presented on a scale http://apps.who.int/gho/data/view.main.SDG2016LEXv (18 October 2018) of 0 to 100. The median national value for service coverage is 65 out of 100 (Hogan DR et al., Lancet, 6:2, 2018, pp.E152-E168, doi: 10.1016/S2214-109X(17)30472-2) E Institute for Health Metrics and Evaluation, GBD compare | viz hub, 2016, https://vizhub. healthdata.org/gbd-compare (18 October 2018) N World Health Organization, Global Health Observatory: universal health coverage, http:// apps.who.int/gho/portal/uhc-cabinet-wrapper-v2.jsp?id=1010501 (23 September 2018) F Institute for Health Metrics and Evaluation, GBD compare O Expressed as a percentage of the population with a household expenditure on health G Institute for Health Metrics and Evaluation, Epi visualization | viz hub, 2017, https://vizhub. greater than 10 per cent of the total household expenditure or income. World Health healthdata.org/epi (18 October 2018) Organization, Global Health Observatory: universal health coverage H Institute for Health Metrics and Evaluation, GBD compare P Expressed as a percentage, based on achieving a median number of 4.2 formal long-term I Institute for Health Metrics and Evaluation, Epi visualization care staff per 100 people aged 65 and older. International Labour Organization,World J Institute for Health Metrics and Evaluation, Epi visualization (original values converted social protection report 2017-19: universal social protection to achieve the Sustainable into percentages) Development Goals, Geneva, International Labour Organization, 2017, table B.14, p.376

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